Smart Technology for Diabetes Self-Care

Wearables, Implants, and Apps, Oh My!

If you have diabetes, you must consistently monitor your diet, lifestyle, and glucose levels, and keeping track of everything can be both inconvenient and difficult. Matters can become even more complicated if you have other health conditions with which to contend. Fortunately, technology can help.

Technological innovations

Strides have been made to ensure technology keeps pace with assisting people in self-managing their diabetes. By incorporating a personalized approach, technology has become a useful tool; in particular, mobile and Internet-ready smartphones have been found to be the most effective for integrating diabetes care into day-to-day living.

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A 2009 study conducted by Julie Polisena and her team at the Canadian Agency for Drugs and Technologies in Health found storing or sharing self-monitored blood glucose using home telehealth tools such as PDAs or fax machines, supported with physician feedback, showed improved glycemic levels and reduced hospitalizations.

Wearable technology

Wearable technology comprises gadgets that can be worn and are equipped with sensors and wireless connectivity to assist with monitoring blood sugar levels, personalizing treatment, connecting with health-care providers, and even delivering medication into the body. It’s a huge departure from the traditional finger pricking method of glucose monitoring.

Some wearables on the horizon for diabetes include smart skin patches, contact lens, and footwear.

Skin Patches: These are small patches enclosing sensors that measure blood glucose in sweat and automatically release a dose of insulin to correct high blood glucose. The patch can be attached to your skin so that in the event of low blood glucose levels, it will send a message alert to your smartphone reminding you to eat. Some patch systems already exist but need a wire to transmit data. Several companies are taking patches a step further by sending information wirelessly.

Pharmaceutical company Abbott has created the FreeStyle Libre Flash Glucose Monitoring System. A patch is placed at the back of the arm. It’s made with a small, round sensor with microfilaments that measure glucose levels in beneath-the-skin fluids per minute. An external device that reads through clothing scans the sensor. This product already is being distributed in certain parts of Europe and is awaiting approval from the U.S. Food and Drug Administration (FDA).

Other companies also are developing patches. Eccrine Systems, Inc., which develops advanced sweat sensors for medicine, plans to release a disposable patch that measures glucose levels in sweat and sends data wirelessly. This device is anticipated to hit the market this year. Google also is working with glucose-monitoring systems developer Dexcom to create a bandage-sized, disposable sensor that can transmit data to the Cloud in real time. It’s estimated to be available in the next five years.

Besides monitoring, patches also can be used for drug delivery. OmniPod, for example, is a small, waterproof patch that active adults and children can wear for three days straight. Before placing it anywhere on the body, insulin is injected into it. A handheld device then can control it to monitor and administer insulin if needed.

Contact Lenses: Smart contact lenses that could monitor blood glucose levels through human tears are being explored by Brian Otis and Babak Parviz for Google[x]. Pharmaceutical company Novartis has agreed to license and commercialize them once available. They also are looking to make lenses that could compensate for poor eyesight, which is a common complication among people with diabetes. There is yet to be confirmation of when this product could reach the market, but in 2015, Google was granted the patent for a contact lens with an embedded chip to monitor glucose levels in tears.

Socks and Shoes: Developments in technology aren’t appearing only in the area of self-monitoring. Technological developments also are prevalent in preventing common diabetes complications such as diabetic neuropathy, which can result in limb amputation. Currently, scientists are prototyping socks and shoes with embedded thermal and pressure sensors that can point out specific areas of the feet that have insufficient blood supply. Once this footwear product reaches the market, ideally, a supporting smartphone application would alert the wearer if one area of the foot is not getting blood supply. A nurse or doctor also can use the device to routinely inspect small cuts or soft tissue damage, in which an infection can easily develop. Such technology would greatly minimize the risk of amputations.

Researchers at the Fraunhofer Institute in Germany are testing a sock equipped with 40 tiny sensors spread across the sole, heel, top of the foot, and ankle to get a three-dimensional reading. When a person stands on one foot too long and pressure starts to build, the sensors signal a wireless device that communicates with a smartphone, which then alerts the person to shift his or her weight to the other foot. Researchers still are working on how to make the sock washable.

The University of Arizona Department of Surgery’s Southern Arizona Limb Salvage Alliance (SALSA) is researching and developing Smart Sox, a stocking made with fiber optics and sensors that monitor pressure, temperature, and joint angles to help avoid the development of foot ulcers. It could be five years before Smart Sox are available for home use.

Implanted technology

Traditionally, people with diabetes use injections or pumps to get insulin, both of which can be uncomfortable and inconvenient. However, companies now are developing implants such as a bio-artificial pancreas and skin implants that automate drug delivery.

A bio-artificial pancreas typically houses stem cells that produce insulin. Viacyte is producing VC-01, which houses the cells in a special capsule that is implanted into the patient’s body to function very much like a pancreas. The product currently is in clinical trials and already has been successfully implanted into four humans. The company is expecting to make more trial human implantations by the end of 2016 and to bring it to market in about five years.

Joan Taylor, professor at the De Montfort University in Leicester, U.K., has developed a wristwatch-sized artificial pancreas called InSmart, which is made of a gel barrier capable of matching the insulin amount it releases based on increases in blood sugar levels. The insulin in the barrier must be replenished every two weeks through an external port. Human testing is set for this year, to make it available in the next decade.

Insulin delivery can be less intrusive in the form of skin implants. Intarcia has developed ITCA 650, a matchstick-sized implant placed under the skin to continually deliver the Type 2 diabetes drug exenatide. This substance traditionally is injected twice daily or once weekly, but the ITCA 650 is implanted only once or twice a year. Currently, it is in phase III clinical trials and is scheduled for FDA filing later this year.

Smart Apps

While many wearables and implanted technology still are in the development or approval phases, many smartphone applications already are available. Apps can educate, assist with decision-making, communicate with health-care providers, and promote adherence to lifestyle and medication regimens.
Some glucose meters now are smaller, lighter, and capable of giving more accurate readings. Some are so small they can be plugged into the headphone jack of a smartphone. Apps that accompany glucose meters include sensors that count the number of steps taken in a day, the number of calories consumed in a meal and the resulting glucose levels, and whether a dose of medication is recommended. The OneTouch Verio® Meter, for example, can test a drop of blood and tell whether sugar levels are within range, as well as provide a summary of overall health performance.

Thousands of apps are being developed without the use of a blood strip to help people with diabetes make wise meal and activity choices and keep blood sugar levels within safe limits. The app Diabetik, for example, is designed for quick and interactive data entry to help those with either Type 1 or Type 2 diabetes monitor their diet, blood glucose levels, and medication. The user can set medication or activity reminders according to time or location.

Other apps focus on keeping food diaries and tracking calories. Fooducate has an extensive database of food information. Through barcode scanning, you can search a food item’s nutritional value and wait for the app to suggest healthier alternatives. The app also creates a community in which you can share your progress and healthy recipes.

Some apps are designed specifically for children, enabling parents to monitor their children’s blood sugar levels throughout the day. The app mySugr Junior has a playful interface that motivates and rewards children to learn about diabetes and religiously monitor their glucose and activity levels. All data are synced with the caregiver’s smartphone.

Other apps focus on connecting patients with their doctors. For example, Glooko is capable of aggregating your biometric data with information gathered through syncing with other glucose monitoring and fitness apps. It allows physicians to easily download patient data through the Glooko Kiosk software, which provides doctors with vital information required during consultations.

The future of smart self-management

It could be years before some wearables and implants currently in development become available for consumer use. Concerns also have been raised about their affordability and the fear that patients will be entirely reliant on technology to manage their condition. However, many free diabetes-related apps succeed in empowering patients to become actively involved with their physicians, treatment regimens and lifestyle changes.

Smart technology remains a promising area of innovation that can dramatically improve the lives of people with diabetes. By reducing the need for constant finger pricking or insulin injections, technology can make glucose monitoring, drug delivery, and health decision-making more efficient. This gives patients and caregivers more time to dedicate to other aspects of their lives, such as relationships and careers. Smart technology also promotes mindfulness in making daily life decisions, the discipline for self-management and self-care, and the formation of health habits. Not only can this help prevent or reduce the progression of diabetes and its complications, but it also can help reduce the costs of diabetes treatment and management.

Nicola Davies is a health psychologist, counselor and freelance writer who provides one-to-one self-management consultancy to people living with chronic conditions. You can follow her on Twitter (@healthpsychuk) or sign up for her free blog at http://healthpsychologyconsultancy.wordpress.com.

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